Equity in U.S. Solid Organ Transplantation for People Living With HIV: An Integrative Review of Barriers, Policies, and Interventions

Although survival for people living with HIV (PLWH) has improved, their need for solid organ transplantation (SOT) is disproportionate. Equitable access remains limited despite the HIV Organ Policy Equity (HOPE) Act, a U.S. federal law enacted in 2013 permitting transplantation from donors with HIV to recipients with HIV under research protocols. This integrative review (PubMed, Embase, CINAHL; 2011-2024) synthesized U.S. studies examining barriers, interventions, and policies affecting access to SOT for PLWH, organized using the Social Ecological Model. Thirty studies met inclusion criteria, with most focused on kidney and liver transplantation with limited evidence for thoracic transplantation. Barriers occurred across individual (stigma, knowledge gaps), organizational (restrictive eligibility), and structural or policy levels (insurance barriers, geographic inequities). Few studies evaluated interventions. Studies evaluating HOPE Act implementation demonstrated reduced wait times and increased transplantation, particularly among Black and publicly insured candidates. Priorities include center accountability and removing research-only barriers to thoracic D+/R+ transplantation.